Some Quebec doctors let suicide victims die though treatment was available: college

MONTREAL — Quebec’s College of Physicians has issued an ethics bulletin to its members after learning that some doctors were allowing suicide victims to die when life-saving treatment was available.

The bulletin says the college learned last fall that, “in some Quebec hospitals, some people who had attempted to end their lives through poisoning were not resuscitated when, in the opinion of certain experts, a treatment spread out over a few days could have saved them with no, or almost no, aftereffects.”

It goes on to spell out a physician’s ethical and legal duty to provide care, even to patients seeking to end their own lives.

Yves Robert, the college’s secretary, told the National Post that an unspecified number of doctors were interpreting suicide attempts as an implicit refusal of treatment. They “refused to provide the antidote that could have saved a life. This was the real ethical issue,” he said.

“If there is a life-threatening situation, you have to do whatever is possible to save a life, then you treat the underlying cause.”

In the four-page bulletin posted on the college’s website last week, the professional order’s working group on clinical ethics says considerations of obtaining patient consent for treatment have to be set aside in such situations.

It would be negligent not to act.

“From a moral point of view, this duty to act to save the patient’s life, or to prevent him from living with the effects of a too-late intervention, rests on principles of doing good and not doing harm, as well as of solidarity,” it reads. “It would be negligent not to act.”

It says treatment should be withheld only in cases where a physician has “irrefutable proof” of a patient’s wishes in the form of an advance medical directive or a do-not-resuscitate order.

Once stabilized, a survivor of suicide may require psychiatric treatment, the bulletin says. “Recognition of psychological suffering can allow a person who wants to kill himself to picture his life differently,” it says.

Robert said the Quebec Poison Control Centre, which provides emergency advice to physicians treating patients who have ingested poisons or pills, alerted the college to the issue.

“They were concerned by these cases,” he said. “It was not a frequent situation, but it was a situation that raised ethical questions on their part, and they wanted to have some advice from the college.” He said he did not know how many cases occurred or in which hospitals. More than 1,000 people die by suicide every year in Quebec.

Maude St-Onge, medical director of the Poison Control Centre, said the centre found emergency-room doctors were not always sure how to proceed when treating people who had attempted suicide.

“We saw doctors at the bedside confronted with problems like this, patients who had attempted suicide,” she said. “There were treatments, antidotes that could have allowed a patient to recover relatively easily, but the patient resists treatment, or the family says, ‘He wanted to die. Let him go.’ ”

She said she is not aware of specific cases where patients were allowed to die, but the college said it learned of incidents from other sources in the health network.

Robert said that even though withholding lifesaving treatment is an ethical breach, the college has no plan to investigate the doctors involved. “We are not in a situation where we can go fishing, trying to see where that happened,” he said.

Bernard Mathieu, president of the 500-member Association of Quebec Emergency Physicians, said he was surprised to hear some of his colleagues were allowing suicidal patients to die. He made a point of sending the college bulletin to all the association members.

“We didn’t want any ambiguity about this necessity to intervene,” he said. Quebec’s debate over physician-assisted death — which led to a law now in force allowing doctors to administer lethal injections to end the suffering of consenting, dying patients — may have contributed to the ambiguity, Mathieu said.

“It’s possible it has confused doctors a little bit,” he said. “Patients are being given the right to no longer live, and doctors are even being asked to help them in certain cases.”

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